Institutional Claims v1 API

The ASC X12N Health Care Claim: Institutional (837i) transaction enables healthcare providers to submit institutional healthcare claims for a service or an encounter. A healthcare claim includes patient information, related diagnoses, procedures performed or services provided, and any related charges. This API also translates the standard X12 EDI 837i transactions to JSON format so that it is more accessible to claim readers and developers.

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NOTE

A single Institutional Claim supports up to 999 service line items.

Before sending to the payer, you can use the Institutional Claims Validation /institutionalclaims/v1/validation endpoint to check and validate your upcoming claim submission. Your transaction will not be sent to the payer. The validation does not examine the actual contents of your claim. It checks for the correct well-formed syntax of the submission and elements, such as correctly summing service line charges and verifying codes.

See Institutional Claims Request & Response

✍️ In the sandbox request, using value: test00005 (lower case and not uppercase), for
fieldName: patientControlNumber returns EDITS canned response.

Related Topics

• API Reference
• Security and Authorization V2
• API URLs and Endpoints
• API FAQs
• Error Messages
• Troubleshoot APIs with Metadata
• ConnectCenter